Revascularization in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS) With Multivessel and/or Unprotected Left Main Coronary Disease (MILESTONE)

Inclusion Criteria:

• Acute Coronary Syndrome without ST elevation (NSTE-ACS): Unstable Angina (Braunwald's class IB,IC,IIB,IIC,IIIB,IIIC) or Non ST Elevation Myocardial Infarction (NSTEMI)
• Two vessel disease with proximal LAD stenosis or three vessel disease
• Unprotected Left Main Coronary Artery (ULMCA) de novo disease with or without concomitant single or multivessel coronary artery disease
• Patient eligible both for CABG and PCI, confirmed by interventional cardiologist and surgeon offering similar extension of revascularisation
• Signed informed consent

Exclusion Criteria:

• age <21
• ST Elevation Myocardial Infarction;
• Stable angina;
• Patients in Killip IV class;
• Patients required immediate PCI procedure (e.g. electric instability);
• Patients unable to tolerate, obtain or comply with dual antiplatelet therapy for at least 1 year
• History of haemorrhagic stroke
• Ischemic stroke or TIA within past 6 weeks.
• Hematocrit <30%
• Platelet Count <100.000/mm3
• Chronic renal insufficiency with creatinine clearance<30 ml/min/1,73m2,
• Concomitant structural or valve disease requiring cardiac surgery
• Prior PCI of left main trunk at any time prior to randomization
• Prior PCI of any other coronary artery lesion within 1 year prior to randomization
• Prior CABG at any time prior to randomization
• Need for any concomitant cardiac surgery other than CABG (e.g. valve surgery, aortic repair, etc.), or intent that if the patient will be randomized to surgery, any cardiac surgical procedure other than isolated CABG will be performed
• Patients requiring additional surgery (cardiac or non cardiac) within 1 year
• Pregnancy or intention to become pregnant (women of child bearing age must have a recent negative pregnancy test prior to randomization)
• Non cardiac co-morbidities with life expectancy less than 3 years